Original article
General thoracic
Cadaveric Lobar Lung Transplantation: Technical Aspects

https://doi.org/10.1016/j.athoracsur.2012.03.051Get rights and content

Background

The use of lobar transplantation and other size reduction techniques has allowed larger donor lungs to be utilized for smaller recipients who tend to have longer waiting times for transplantation. However, despite these advantages, the techniques have not been widely adopted. We outline the surgical and sizing issues associated with this technique.

Methods

A retrospective review of 23 consecutive patients who received lung transplantation with anatomic lobar reduction was performed, focusing on surgical technique and outcomes.

Results

All 23 patients received an anatomic lobar reduction of between 1 and 3 lobes. Survival analysis showed no difference between the lobar reduction cohort and the other historically comparable lung transplant patients from our institution (p = 0.115). Percent predicted forced vital capacity and forced expiratory volume in 1 second at 3 months correlated with transplanted donor to recipient total lung capacity ratio, confirming the importance of correct sizing.

Conclusions

Anatomic lobar reduction in lung transplantation is a safe and effective means of transplanting pediatric and small adult recipients, and urgently listed patients.

Section snippets

Patients and Methods

Since the inception of our lung transplant program in 1990 to the end of February 2012, we have performed 885 lung transplants. Of these, 569 bilateral sequential, 253 single, and 63 heart-lung transplants have been performed. In 2005, in an effort to improve the waiting list servicing of smaller recipients, we decided to perform lobar transplantation in a select group of recipients when size mismatching occurred. Since then, we have become the national pediatric lung transplant center and have

Results

Analysis of the TLC ratio between donors and recipients shows a variation from 0% to 300% discrepancy (Table 1). Eight patients had a predicted TLC discrepancy of less than 20%, but the recipient chest cavity size mandated lobar reduction. These patients tended to have either bronchiectasis or pulmonary fibrosis.

The lobectomies performed are outlined in Table 2. Thirteen patients required CPB during the operation, instituted for a variety of reasons including awake institution of peripheral CPB

Comment

The use of cadaveric lobar transplant is not widespread, despite the advantages this gives to size disadvantaged and urgent waiting list candidates. The published literature consists of only a few case series of cadaveric lobar transplants, most of which have been performed in high volume lung transplant centers [3, 5, 6, 7, 8, 9, 10, 11]. We have demonstrated a correlation between transplanted D/R TLC ratio and both % predicted FVC and FEV1. This has not been previously reported in a cadaveric

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